Provider Demographics
NPI:1912445248
Name:CHAMPIONS SERENE COMFORT CARE HOSPICE LLC
Entity Type:Organization
Organization Name:CHAMPIONS SERENE COMFORT CARE HOSPICE LLC
Other - Org Name:CHAMPIONS SERENE COMFORT CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-928-2442
Mailing Address - Street 1:12816 WILLOW CENTRE DR STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-3034
Mailing Address - Country:US
Mailing Address - Phone:281-928-2442
Mailing Address - Fax:281-919-1124
Practice Address - Street 1:12816 WILLOW CENTRE DR STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-3034
Practice Address - Country:US
Practice Address - Phone:281-928-2442
Practice Address - Fax:281-919-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based